Despite recent advances in heart failure management, hospitalization rates remain high, and the cost of heart failure care continues to escalate. Women, elderly patients, residents of rural communities and the economically disadvantaged are at substantial risks for frequent hospital readmissions and poor functional outcomes. The potential cost savings of telemonitoring high risk heart failure patients have not been evaluated. We postulated that a telehealth disease management program will improve treatment adherence, patient satisfaction and reduce resource utilization in high risk heart failure patients. Specific Aims: 1) Evaluate the effectiveness of a telemonitoring patient oriented intervention to improve access to ambulatory heart failure patients, and examine the cost effectiveness of telemonitoring in rural, compared to suburban and urban heart failure patients. Methods: This prospective single blind randomized study will enroll 350 heart failure patients 65 years or older over 4 years. Eligibility: Recently discharged heart failure patients who were hospitalized at least once in the preceding 6 months of recurrent heart failure exacerbations requiring at least two emergency room or office visits over 3 months. Enrolled patients will be randomized to a 4 week telehealth intervention versus usual care. Primary Outcome: Ninety day health care resource utilization rate (hospital admissions, emergency room visits and office visits for heart failure exacerbation). Secondary outcomes: Cumulative number of days of hospitalization over 90 days; costs of medical care, and telemedicine use survey. The patient oriented aspects of this program in addition to the geographic and socioeconomic diversity of the study population should provide important bench marks for effective teleheart failure delivery model.